Showing papers in "Československá patologie in 2010"

Guidelines for autopsy investigation of sudden cardiac death.

Abstract: Although sudden cardiac death is one of the most important mode of death in Western Countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed, and the accurate diagnosis of the causes of sudden cardiac death is now of particular importance. Pathologists are responsible for determining the precise cause of sudden death but there is considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology developed guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate assessment of sudden cardiac death, including not only a protocol for heart examination and histological sampling, but also for toxicology and molecular investigation. Our recommendations apply to university medical centres, regional and district hospitals and all types of forensic medicine institutes. If a uniform method of investigation is adopted throughout the European Union, this will lead to improvements in standards of practice, allow meaningful comparisons between different communities and regions and, most importantly, permit future trends in the patterns of disease causing sudden death to be monitored.

Blood vessels and lymphatics in calcific aortic stenosis - in support of its inflammatory pathogenesis

Abstract: In developed countries, calcific aortic stenosis (CAS) has become the most common acquired valvular disease. It is considered a for of atherosclerosis and, like the latter, of inflammatory origin. Majority of cases of CAS are classified etiologically as either senile ("degenerative")--developing on previously normal aortic valve with three cusps, or based on congenitally malformed--bicuspid aortic valve. Twenty-eight cases of CAS (18 of the senile type, 7 of the bicuspid valve type, and 3 of indeterminable type) were examined by means of histology and immunohistochemistry (CD31 for blood vessels; D2-40 for lymphatics). In the calcified cusps, blood vessels were present in all 28 cases, and lymphatics in 14 of them. Vascularization was associated with lymphocytic infiltrates in 24 cases. There was no difference in the pattern between the two types of CAS. The origin of the cusp vessels is discussed. Our finding in the calcified cusps of both blood and lymphatic vessels together with lymphocytic infiltrates supports the inflammatory theory of the CAS pathogenesis.

Histologic findings after sodium phosphate bowel preparation for colonoscopy. Diagnostic pitfalls of colonoscopic biopsies.

Abstract: Oral sodium phosphate (NaP) has been increasingly used for bowel preparation before the colonoscopy because it shows good patients tolerance and effective bowel cleansing ability. However, new studies describe that NaP can induce colonic mucosal damage. For better characterization of these changes, we examined histologically segmental colonic biopsies from 42 patients receiving NaP bowel solution before the colonoscopy. The series includes 25 male and 17 female patients in age from 19 to 81 years (average age 46.7 ys). Clinical symptoms in 37 patients included diarrhea, constipation, bleeding and abdominal cramps. The most frequent reason for colonoscopy was suspicion of microscopic colitis. Five patients underwent endoscopy to rule out the presence of neoplasia. None of the patients took drugs before the colonoscopy. Histologically, all specimens showed mild focal edema, hyperemia and hemorrhages. In addition to edema and hemorrhage, in 26 patients (61.9%), patchy mononuclear infiltration in the upper part of lamina propria and increased epithelial cell proliferation of individual crypts were seen. Mucosal structure was normal, with partial sloughing of normal or flattened surface epithelium. In 5 patients (11.9%), some biopsy samples contained scattered neutrophilic leucocytes in the lamina propria/superficial epithelium, isolated basal cryptitis, increased proliferation and apoptosis of the crypt epithelium. In two patients with focal cryptitis (4.8%), small erosions were found. Mild basal cryptitis, increased proliferation and striking apoptosis were present in two inflammatory pseudopolyps (in two patients). In 4 patients, solitary tubular adenomas with low-grade dysplasia without any reactive changes were found. In addition, 300 hyperplastic polyps removed endoscopically after the NaP application, were examined. Two polyps (0.75%) showed cryptitis and isolated multinucleated epithelial cells in the superficial part of the crypts. Our results are similar to those previously described in other studies of colonic changes after the NaP application. It reflects probably a similarity in composition of used NaP solutions.

Nerve sheath myxoma with bidirectional schwannomatous and perineural differentiation.

Abstract: A case of nerve sheath myxoma occurring in occipital region in 70-yr-old woman is presented The tumor showed typical lobular and myxoid morphology Immunohistochemically, it showed unusual coexpression of Schwann cell markers S100 protein and GFAP with perineural cell markers EMA and claudin-1 CD34+ fibroblast-like cells were scarce, and nerve axons were not found in the tumor Clinical pathology and histogenesis of the lesion are discussed

Prolonged treatment of chronic renal insufficiency, acquired cystic kidney disease, simultaneous precancerous lesions and multiple tumors of left kidney.

Abstract: Purpose of the investigation Description of precancerous lesions and kidney tumors developing in a patient with chronic uremia treated by long-term hemodialysis Most important methods Light microscopy, polarization and immunohistochemistry with CK1/CK3, CK5/6, CK7, CK8, CK20, EMA, Renal cell, CD10, Ki-67, PCNA, p53 and E-cadherin antibodies were used Main findings After 11 years of hemodialysis treatment of end-stage diabetic nephropathy and chronic tubulointerstitial nephritis an urgent left-sided nephrectomy was performed because of pain and massive intrarenal bleeding Biopsy revealed acquired cystic kidney disease associated with multiple precancerous lesions, several small papillary adenomas and a multifocal renal cell carcinoma with conventional and papillary structures with admixture of small foci of highly cellular sarcomatoid features Severe vascular nephrosclerosis and uremic oxalosis were additional findings The upper pole of the kidney was massively hemorrhagic Principal conclusions This case illustrates the association of chronic renal insufficiency, uremic oxalosis, long-term hemodialysis, acquired cystic kidney disease and development of variable precursor intratubular and intracystic lesions progressing to several papillary adenomas and multifocal renal cell carcinomas with variegated microscopic structures in one kidney

[IgG4-related systemic sclerosing disease: a review].

Abstract: IgG4-related systemic sclerosing disease (SSD) is a multisystemic condition characterized by an increased number of IgG4-producing plasma cells which occurs mainly in older men. SSD involves particularly pancreas, hepatobiliary system, salivary glands and retroperitoneum. Microscopically, the findings include lymphoplasmacytic inflammation, fibrosis and vascular changes in the form of obliterative phlebitis. Using immunohistochemistry, an increased number of IgG4-positive plasma cells might be detected in affected tissues. Since SSD frequently mimicks a malignancy both clinically and radiologically, this inflammatory sclerosing condition should be considered in the differential diagnosis of neoplastic and/or pseudoneoplastic lesions.

Histopathological classification of idiopathic interstitial pneumonias

Abstract: The classification scheme of interstitial lung diseases has undergone numerous revisions The criteria for distinguishing seven distinct subtypes of idiopathic interstitial pneumonias are now well defined by consensus in the recently published ATS/ERS classification of these lung diseases In our present review the histological patterns of the different types are described and the differential diagnosis of idiopathic interstitial pneumonias is discussed Surgical lung biopsy remains the gold standard for the diagnosis of interstitial pneumonias, and sampling from at least 2 sites is recommended Video-assisted thoracoscopic surgical biopsy is the preferred method for obtaining lung tissue as this procedure offers a similar yield as an open thoracotomy The most common histological subtype of chronic interstitial lung disease is the usual interstitial pneumonia [UIP] which makes up 47-71% of cases The key histologic features include patchy subpleural and paraseptal distribution of remodeling lung architecture with dense fibrosis, frequent honeycombing, and large fibroblastic foci Temporal and spatial heterogeneity are the hallmarks Nonspecific interstitial pneumonia [NSIP] occurs primarily in middle-aged women who have never smoked, with more than 5-years survival rate in 80% of patients The major feature of NSIP is a uniform interstitial thickening of alveolar septa by a fibrosing or cellular process The cardinal histological feature in respiratory bronchiolitis and desquamative pneumonia is an excess of intraalveolar histiocytes In both patterns, there is variable interstitial fibrosis and chronic inflammation, and a strong association with a history of smoking Organizing pneumonia (idiopathic bronchiolitis obliterans-organizing pneumonia [BOOP]) is not strictly an interstitial process, because the alveoli and bronchioles are filled by intraluminal polyps of fibroblastic tissue and the expansion of the interstitium is mild Lymphocytic interstitial pneumonia [LIP] is currently viewed as a pattern of diffuse reactive pulmonary hyperplasia associated in most cases with EB virus, immunosuppression, or a connective tissue disorder Malignant transformation may rarely occur A dense mixed interstitial lymphoid infiltrate is a typical histological finding Diffuse alveolar damage [DAD] from unknown causes is termed acute interstitial pneumonia [AIP], and is synonymous with cases of Hamman-Rich disease Hyaline membranes in the exsudative phase and marked expansion of the interstitium later are present

[False negative PAP test? Cytopathologist as a member of expert group in case of late diagnosis of cervical cancer].

Abstract: The Pap test represents a potent tool in reducing the incidence of cervical cancer, though it is unable to eradicate it totally. Under standardized application it has a (very low) failure rate unexpected by the public. In relation to the National screening program of cervical carcinoma an increase in number of litigation cases is to be expected started by women who took part in the screening program and still developed cervical cancer. Together with the international guidelines of Pap test administration and evaluation (Bethesda 2001), widely adopted guidelines for Expert review of histologic slides and Papanicolaou tests in the context of litigation or potential litigation have been formulated (College of American Pathologists 20001). Arguments for adoption of these guidelines by the Czech Society of Pathologists and their implementation into the National Program of Cervical Cancer Screening are presented.

The role of molecular biology in detection and monitoring of prostate cancer.

Abstract: Summary The study of molecular markers in various types of human carcinomas, as well as in carcinoma of prostate, is focused on genes responsible forthe formation of carcinoma. Mutation, amplification or other changes in these genes or in their protein products are being exam ined and comparedto traditional prognostic markers. These genes can be characterized as oncogenes, tumor suppressor genes or genes for other significant cellfunctions. However, studies are often limited by heterogenity and multifocality of tumors, especially in prostate cancer. In this review, we offera survey of some of the most frequent diagnostic and prognostic parameters of molecular biology research in relation to prostatic carcinoma. Key Words: prostate cancer – molecular biology – molecular markers SuhrnUloha molekularnej biologie pri diagnostike a monitoringu karcinomu prostaty Studium molekulových markerov v roznych neoplaziach ako aj pri karcinome prostaty je založene na analýze genov, ktore sa spolupo dieľaju navzniku karcinomu. Boli sledovane mutacie, amplifikacie a ine zmeny týchto genov alebo ich produktov, ktore su porovnavane s tradicnýmiprognostickými markermi. Tieto geny možno oznaciť ako onkogeny, tumor supresorove geny alebo geny s inými významnými bunkovýmifunkciami. Studie karcinomu prostaty su casto limitovane heterogenitou tohto nadoru. V predloženej praci predkladame prehľad niektorýchnajcastejsich diagnostických a prognostických molekulovo biologických markerov vysetrovaných v suvislosti s karcinomom prostaty.

Autosomal dominant polycystic kidney disease in the fetus with seemingly negative family history. A case report

Abstract: An unusual case of fetal polycystic kidney disease is reported. Oligohydramnios and enlarged hyperechogenic kidneys were found at 21 weeks. The pregnancy was terminated and fetal autopsy performed. The histopathological pattern of fetal kidneys was consistent with glomerulocystic disease and this raised suspicion of autosomal dominant polycystic kidney disease (ADPKD). Initially, the family history seemed to be negative for ADPKD. The mother's diagnosis was established only after the abortion of the affected fetus. She had no symptoms of renal disease. Multigenerational involvement was revealed on the mother@s side. Mechanisms leading to prenatal ADPKD and prognosis of the pediatric patients are discussed.

[Muir-Torre syndrome--a phenotypic variant of Lynch syndrome].

Abstract: Muir-Torre syndrome (MTS) represents an autosomal dominantly inherited condition and is considered a phenotypic variant of the more common hereditary nonpolyposis colorectal cancer syndrome (HNPCC), or Lynch syndrome. MTS combines at least one cutaneous neoplasm with sebaceous differentiation (e.g. sebaceoma, sebaceous adenoma, and sebaceous carcinoma), and at least one visceral malignancy. MTS is a genetic disorder caused by a germline mutation in one of the DNA mismatch repair (MMR) genes. Tumors in MTS patients are characteristically associated with the loss of MMR protein expression and/or microsatellite instability (70%). Patients who are suspected to have MTS/Lynch syndrome are often identified by dermatologists, dermatopathologists/pathologists, gastroenterologists and gynecologists. If MTS is suspected on a clinicopathological ground, necessary additional laboratory investigations should be performed only in specialized pathological departments providing immunohistochemistry and molecular biologic analysis service.

Lymphoma of the small intestine

Abstract: A series of eight small intestine lymphomas comprised two cases of follicular lymphoma (FL), one anaplastic large cell lymphoma (ALCL) ALK negative, and five cases of diffuse large B-cell lymphoma. The lymphomas were diagnosed by routine hematoxylin-eosin staining, immunohistochemistry and the FISH method for translocation t(14;18). Immunohistochemistry revealed that the diffuse large B-cell lymphomas were of the non-germinal center type (non GC-DLBCL). In most cases, the tumors formed solid well-circumscribed nodules or resulted in diffuse infiltration of the intestinal wall. In one case of follicular lymphoma, microscopic foci of tumor were found in the intestinal mucosa which spread far from the primary nodule and probably beyond the resection border. It is difficult to ascertain whether this phenomenon represents colonization of pre-existing non-neoplastic follicles by lymphoma or spreading of the tumor within the same tissue. In this case, surgical removal of the lymphoma is problematic.

Analysis of bone marrow angiogenesis in multiple myeloma

Abstract: The authors studied angiogenesis in trephine biopsy samples taken from the hip bone from a total of 51 patients with an as yet untreated plasma cell myeloma / multiple myeloma (MM). Microvessel density calculated to 1 mm2 was represented by monoclonal antibodies against CD34 and nestin. It was discovered that proliferating vessels labeled with anti-nestin antibody nearly never occur in the interstitial type of infiltration. The amount of proliferating vessels in nodular infiltrates is significantly lower compared to the capillary network labeled with antibodies against CD34. The density of proliferating vessels in nodular infiltrates significantly correlates with the proliferation index Ki67 of myeloma cells, not, however, with the degree of MM differentiation.

[Ovarian carcinoma: current diagnostic principles]

Abstract: Ovarian cancer is the most common cause of death from a gynecologic cancer. The most common types of ovarian cancer are carcinomas of surface epithelial-stromal origin. Ovarian carcinomas are a heterogeneous group of neoplasms. Based on proposed different pathways of tumorigenesis, these tumors are divided into two broad subgroups (type I and II) with different biologic behaviour, prognosis and response to therapy. Type I tumors include low-grade serous adenocarcinoma, low-grade endometrioid adenocarcinoma, mucinous adenocarcinoma, malignant Brenner tumor and some clear cell carcinomas. These tumors are low-grade neoplasms evolving from a defined precursor lesion. Type II tumors are high-grade neoplasms including undifferentiated carcinoma, high-grade serous adenocarcinoma, high-grade endometrioid adenocarcinoma, malignant mixed Mullerian tumor and probably some clear cell carcinomas. At present, the histological type of ovarian carcinoma has only limited impact on the management of these tumors. However, with progress towards the type-specific treatment of ovarian carcinoma, accurate histopathological diagnosis of ovarian carcinoma becomes increasingly important. In this review we summarize recent advances in the histopathological diagnosis of ovarian carcinoma. Moreover, we mention genetic changes in different types of ovarian carcinoma.